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Illustration: Lazaro Gamio / Axios

Senate Republicans are on the verge of passing a sweeping health care bill not only without knowing what's in it, but without particularly caring. The political abstraction of "Obamacare" — and the seven years of promises to "repeal Obamacare" — have almost totally overshadowed even the broad strokes of policy, much less the details.

The bottom line: The repeal-and-replace bill sponsored by Sens. Lindsey Graham and Bill Cassidy is gaining steam because it has the appearance of gaining steam — not because of the changes it would make. "If there was an oral exam on the contents of the proposal, graded on a generous curve, only two Republicans could pass it. And one of them isn't Lindsey Graham," a senior GOP aide told Caitlin.

The big picture: The ACA had all sorts of unanticipated quirks and unintended consequences — and Democrats spent almost a year working on it. A bill written in a couple weeks, whose scope is even bigger than the ACA's, is sure to have some, too. And yet, many rank-and-file Republicans have barely reckoned with the very big things the bill would do intentionally.

  • "I am just in shock how no one actually cares about the policy any more," one GOP lobbyist told Caitlin.

The details: Graham-Cassidy would roll federal funding for the ACA's premium subsidies and Medicaid expansion into a single pot, reduce the overall size of that pot, and distribute it to states according to a complex formula. On top of that, it would impose new caps on federal Medicaid spending. Together, those cuts would dramatically roll back the federal government's role in health care and would almost surely lead to millions more uninsured people than the status quo.

The unknowns: The Congressional Budget Office says it will release a "preliminary assessment" of the bill early next week, but it won't include critical details like how the bill would affect premiums and the number of people with health insurance. So if the Senate votes before Sept. 30 — the deadline for being able to repeal the ACA through budget “reconciliation" rules — it won't have any of that information. (Independent estimates suggest that those effects would be staggering.)

But you don't hear a lot of Republicans worrying about that. They think CBO is too slow and has overstated the negative impact of the previous bills. "I think we can pretty well decide based on the information we already have," Sen Ron Johnson said yesterday on CNN.

How we got here: Graham-Cassidy would be the fourth repeal bill to get a vote in three months — if it gets one.

  • "This is like the Lazarus of health care bills. It's back, and I don't know exactly why that is," conservative policy analyst Douglas Holtz-Eakin — who's on board with many of the bill's policy goals — told Sam. "If it was just a policy argument, I don't think it would have come back."

Those bills vary significantly. None of Graham-Cassidy's predecessors in the Senate included a similar system of state block grants. Only one would have eliminated the ACA's premium subsidies; a different one would have made similar changes to Medicaid. Yet they all got between 43 and 49 votes.

  • "You could do a post office renaming and call it 'repeal-replace' and 48 Republican senators would vote for it sight unseen," the GOP aide said.

Go deeper

Scoop: Trump-backed Perdue says he wouldn’t have certified Georgia 2020 results

Perdue at a December 2020 campaign event in Columbus, Ga. Photo: Elijah Nouvelage/Getty Images

Georgia gubernatorial candidate David Perdue wouldn’t have signed the certification of the state’s 2020 election results if he had been governor at the time, the former Senate Republican told Axios.

  • “Not with the information that was available at the time and not with the information that has come out now. They had plenty of time to investigate this. And I wouldn’t have signed it until those things had been investigated and that’s all we were asking for," he said.

Why it matters: There has been no evidence widespread fraud took place in Georgia's elections last year and the November results were counted three times, once by hand.

Beijing Olympics: These countries have announced diplomatic boycotts

Photo: Zhang Qiang/VCG via Getty Images

Several countries, including Canada and Australia, have announced they will join the U.S. in a diplomatic boycott of the 2022 Beijing Winter Olympics to protest human rights abuses committed by China's government.

Driving the news: Leaders have faced pressure from human rights groups and others to boycott the Games, pointing to the ongoing genocide of Uyghurs and other Muslim minorities in China's Xinjiang region and other abuses.

Biden directs federal government to become carbon neutral by 2050

President Biden speaking to reporters outside of the White House on Dec. 8.

President Biden signed an executive order Wednesday that requires the federal government achieve multiple goals related to reducing its carbon emissions, including achieving net-zero emissions by 2050.

Why it matters: Meeting the objectives of the order would require a massive investment by the federal government to buy electric vehicles, upgrade buildings and change how it procures electricity.